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COPD Prevalence 9% in French HIV Group--and 74% Don't Know
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ICAAC 2014. September 5-9, 2014. Washington, DC
Mark Mascolini
Prevalence of chronic obstructive pulmonary disease (COPD) stood at 9% in a cross-sectional study of 581 HIV-positive people in France [1]. Three quarters of the group did not know they had COPD.
Older age and smoking are well-known respiratory risk factors, so respiratory disease may become a growing problem as HIV-positive people live longer thanks to antiretroviral therapy. Smoking remains highly prevalent among people with HIV. But not every HIV-positive person with COPD is old and smokes: A recent study found a COPD prevalence of 7% in 1026 international START trial participants with a median age of 36, and half of those with COPD reported never smoking [2].
The French study involved HIV-positive outpatients seen over the course of 2012 at the University Hospital Center in Nice. Participants completed a questionnaire about respiratory complaints, known COPD diagnosis, and prior hospital admission for respiratory conditions. All participants had lung function measured by a handheld spirometer. The researchers checked electronic medical records for relevant variables.
The study group included 581 people with an average age of 48.3 (+/- 9.9). About three quarters of participants were men. Overall, 136 people (23%) had respiratory symptoms, including chronic bronchitis (8%), recurrent acute bronchitis (9%), and dyspnea (17%). Half of study participants were current smokers, and 72% were current or past smokers. HIV infection duration averaged 15.5 years and CD4 count 622. Most people (93.5%) were taking combination antiretroviral therapy, and 85% had an undetectable viral load. One third had HCV infection.
By spirometric criteria, 52 of 581 people (9%) had COPD. Among people with COPD, only 9% had prior spirometry, 9% were receiving respiratory therapy, and 74% did not know they had COPD.
People with COPD were older than those without COPD (average 52.5 versus 47.9, P = 0.001) and had a lower body mass index (average 21.5 versus 23.7 kg/m2, P < 0.001). Higher proportions of people with COPD ever smoked (90.4% versus 69.9%, P = 0.002), ever smoked marijuana (55.1% versus 38.9%, P = 0.028), and ever injected drugs (35.3% versus 16.6%, P = 0.001).
Participants diagnosed with COPD were more likely to have HCV infection (50% versus 31.6%, P = 0.007) and more likely to have depression (36.5% versus 19.5%, P = 0.004).
HIV history had an impact on COPD prevalence. Those with COPD had HIV infection longer (average 18.7 versus 15.2 years, P = 0.005), had a lower average CD4 count (497 versus 634, P = 0.001), and had a lower nadir CD4 count (188 versus 262, P = 0.007). Antiretroviral treatment status (naive versus experienced) or antiretroviral class did not vary significantly by COPD diagnosis.
Multivariate analysis linked two factors to higher odds of COPD: older age (odds ratio [OR] 1.61, 95% confidence interval [CI] 1.14 to 2.28, P = 0.007) and more pack-years smoking (OR 1.28, 95% CI 1.09 to 1.50, P = 0.003). Factors associated with lower chances of COPD were higher body mass index (OR 0.78, 95% CI 0.70 to 0.89, P < 0.001) and every 100-cell higher current CD4 count (OR 0.77, 95% CI 0.68 to 0.88, P < 0.001).
The NICE team also used multivariable analysis to identify independent predictors of 2 to 4 times more prevalent COPD:
-- Age over 50: OR 2.37 (95% CI 1.17 to 4.80, P = 0.017)
-- Body mass index below 21 kg/m2: OR 4.07 (95% CI 1.99 to 8.34, P < 0.001)
-- Current or past smoking: OR 3.40 (95% CI 1.12 to 10.35, P = 0.031)
-- Respiratory symptoms: OR 3.49 (95% CI 1.74 to 7.00), P < 0.001)
-- Previous lower respiratory tract infection: OR 2.73 (95% CI 1.34 to 5.55, P = 0.006)
-- CD4 count below 500: OR 2.19 (95% CI 1.09 to 4.40, P = 0.027)
The researchers suggested clinicians can use these six variables to identify patients at risk for COPD. They called on colleagues to improve diagnosis and care of COPD in people with HIV.
References
1. Risso K, Guillouet-de-Salvador F, Valerio L, et al. Chronic obstructive pulmonary disease in a large cohort of HIV-infected patients: prevalence and predictive factors. ICAAC 2014. September 5-9, 2014. Washington, DC. Abstract H-1196.
2. Kunisaki K, Niewoehner D, Collins G, et al. AIDS 2014. Chronic obstructive pulmonary disease (COPD) in a large international cohort of HIV-infected adults with CD4+ counts >500 cells/mm3. 20th International AIDS Conference. July 20-25, 2014. Melbourne. Abstract WEAB0104. http://www.natap.org/2014/IAC/IAC_26.htm
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